- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,576.15 / $7,119.04
| Facility | | $2,218.00 | $3,576.15 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.25 / $627.79 / $1,423.22
| Professional | | $409.25 | $627.79 | $1,423.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.69 / $1,080.00 / $6,267.00
| Facility | | $487.69 | $1,080.00 | $6,267.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.38 / $1,162.32 / $2,961.89
| Facility | | $759.38 | $1,162.32 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $4,663.00 / $7,305.00
| Facility | | $3,044.00 | $4,663.00 | $7,305.00 |